Perioperative Dexamethasone in Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized, Placebo-Controlled Trials

Anesthesia & Analgesia, Год журнала: 2024, Номер 139(3), С. 479 - 489

Опубликована: Авг. 16, 2024

BACKGROUND: The perioperative use of dexamethasone in diabetic patients remains controversial due to concerns related infection and adverse events. This study aimed determine whether clinical evidence supports withholding concern for risk. We hypothesized that there is no difference infectious outcomes between dexamethasone-treated controls. METHODS: A literature search was performed on November 22, 2022 identify randomized, placebo-controlled trials investigating short-course (<72 hours), explicitly included measured at least 1 outcome. Pertinent studies were independently searched PubMed, Embase, Cochrane. Authors all identified contacted with the aim performing quantitative subgroup analyses patients. primary end point surgical site secondary a composite Qualitative remarks reported based total available data quality assessment tool. Meta-analyses using inverse variance random effects. Heterogeneity assessed via standard χ 2 I tests. RESULTS: Sixteen unique included, 5 which analyzed quantitatively. Of 2592 patients, 2344 (1184 randomized 1160 placebo) Quantitative analysis showed had effect risk infections (log odds ratio [LOR], −0.10, 95%; 95% confidence interval [CI], −0.64 0.44) while significantly reducing events (LOR, −0.33; CI, −0.62 −0.05). reinforced these findings, demonstrating noninferior superior results across outcomes. There high heterogeneity studies. CONCLUSIONS: Current suggests may be given without increasing complications. Prospective investigations optimizing dose, frequency, timing are needed, as well exploring poorly controlled diabetes.

Язык: Английский

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Impact of Dexamethasone on Blood Glucose After Total Knee Arthroplasty in Patients With Type 2 Diabetes

Orthopaedic Surgery, Год журнала: 2025, Номер unknown

Опубликована: Янв. 28, 2025

ABSTRACT Objective With the global aging population, incidence of OA is rising annually, and number TKA surgeries rapidly increasing, placing a heavy economic healthcare burden on society. As one key medications in ERAS protocol, DXM can significantly reduce postoperative pain, suppress nausea vomiting, accelerate patient recovery. However, safety perioperative use patients with diabetes remains unclear. This study aims to clarify application diabetic patients. Methods retrospective analysis involved 285 type 2 late‐stage knee osteoarthritis who underwent unilateral at Joint Surgery Center Peking University Third Hospital from January 2019 November 2022. After inclusion exclusion criteria, 161 were included study. The divided into two groups according whether they had received continuous intravenous administration for 3 days postoperatively: group ( n = 66) non‐DXM 95). All other treatments same both groups. patients' PBG, PONV, length hospital stay, pain scores, clinical data collected compared between Results There no significant differences general preoperative average PBG proportion levels exceeding 200 mg/dL not different (10.84 vs. 11.05 43.2% 43.9%). visual analog scale scores (3.67 2.48) PONV lower than (40% 16%). level glycated hemoglobin accurately predicted PBG. Furthermore, there statistically early complications Conclusions after effectively occurrence without affecting diabetes. In addition, predict

Язык: Английский

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Perioperative Systemic Corticosteroids in Modern Total Hip and Knee Arthroplasty

JBJS Reviews, Год журнала: 2024, Номер 12(9)

Опубликована: Сен. 1, 2024

» Perioperative corticosteroids are strongly recommended for reducing the incidence and severity of postoperative nausea vomiting following elective total hip or knee arthroplasty. Corticosteroids may reduce pain opioid requirements. Similarly, appear to have a neutral-to-positive effect on length stay, venous thromboembolism, mobility, delirium, acute kidney injury, bone cement implantation syndrome (i.e., decreased stay). induce hyperglycemia among both diabetic nondiabetic patients; however, there is no strong evidence indicating that these transient corticosteroid-induced glycemic derangements increase risk infectious complications. The dosage frequency perioperative corticosteroid administration play critical role in optimizing outcomes, with higher doses showing promise consumption, pain, stay. optimal remain unclear; 8 16 mg dexamethasone, equivalent steroid, appears reasonable safe most cases.

Язык: Английский

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Dexamethasone is Associated with Lower Rates of Pulmonary Complications Following Cemented Femoral Fixation During Primary Total Hip Arthroplasty

The Journal of Arthroplasty, Год журнала: 2025, Номер unknown

Опубликована: Март 1, 2025

Язык: Английский

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Effects of high-dose dexamethasone on postoperative opioid consumption and perioperative glycaemia in fast-track primary hip arthroplasty: a retrospective cohort study

International Orthopaedics, Год журнала: 2025, Номер unknown

Опубликована: Апрель 3, 2025

Standard recommendations for fast-track hip arthroplasty suggest using 8-10 mg of dexamethasone to reduce opioid consumption, with potential benefits higher doses but scarce data on glycaemic control and complications. This study compares the effects versus standard postoperative secondarily, numerical pain scale, control, hospital length stay Retrospective cohort patients scheduled FAST-TRACK primary between 2016 2021. Propensity score-matched analyses compared dose group (4-8 mg) high-dose (16-24 mg). 168 were included (56 4-8 mg, 112 16-24 After one-to-one propensity score matching, 52 in group. median [IQR] consumption low-dose was 10 [0-12] 0 [0-10], a 95% CI -1 (p = 0.016). In matched group, there difference 8 mg/dL (95% CI, -2 7, P < 0.05) immediate glycaemia, 17 mg/dl 14, glycaemia at 24 h day 0, stay. No differences scale complications found. High-dose slightly increased perioperative while reducing shortening

Язык: Английский

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Intravenous Dexamethasone Transiently Elevates Blood Glucose Levels and Reduces Pain After TKA in Patients with Type-2 Diabetes Mellitus

Journal of Bone and Joint Surgery, Год журнала: 2025, Номер unknown

Опубликована: Апрель 6, 2025

Background: Effective perioperative blood glucose control is crucial for reducing postoperative complications in patients with diabetes mellitus (DM) who are undergoing total knee arthroplasty (TKA). The aim of this study was to assess the impact intravenous (IV) dexamethasone on levels, insulin requirements, pain, and nausea vomiting (PONV) well-controlled type-2 DM. Methods: A 83 Asian DM (defined as a preoperative glycated hemoglobin level ≤7.0%) primary TKA were randomized receive either IV or normal saline solution. Blood requirements monitored postoperatively up day 5, pain PONV assessed using numeric rating scale. Results: Compared control, transiently elevated levels surgery 1, returning baseline by 3. Insulin higher intervention group 1 (p = 0.004). While did not significantly reduce PONV, it effectively alleviated Conclusions: In underwent TKA, administration increased 1. Despite having no provided clinical benefits early pain. These findings suggest potential enhancing management strategies TKA. Level Evidence: Therapeutic I . See Instructions Authors complete description evidence.

Язык: Английский

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Response to Letters to the Editor: Is Dexamethasone Administration During Total Hip and Knee Arthroplasty Safe in Diabetic Patients?

Journal of the American Academy of Orthopaedic Surgeons, Год журнала: 2025, Номер unknown

Опубликована: Апрель 17, 2025

Язык: Английский

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Dexamethasone has a Synergistic Effect on Liposomal Bupivacaine in Reducing Postoperative Pain After Total Shoulder Arthroplasty

JSES Reviews Reports and Techniques, Год журнала: 2025, Номер unknown

Опубликована: Май 1, 2025

Язык: Английский

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Effects of High-Dose Dexamethasone on Postoperative Opioid Consumption and Perioperative Glycemia in Fast-Track Primary Hip Arthroplasty: a Retrospective Cohort Study

Research Square (Research Square), Год журнала: 2024, Номер unknown

Опубликована: Дек. 16, 2024

Background and Purpose - Standard recommendations for fast-track hip arthroplasty suggest using 8–10 mg of dexamethasone to reduce opioid consumption, with potential benefits higher doses but scarce data on glycemic control complications. This study compares the effects versus standard postoperative secondarily, numerical pain scale, glycaemic control, hospital length stay complications.Methods Retrospective cohort patients scheduled FAST-TRACK primary between 2016–2021. Propensity score-matched analyses compared dose group (4–8 mg) high-dose (16–24 mg).Results 168 were included (56 4–8 mg, 112 16–24 mg). After one-to-one propensity score matching, 52 in group. median [IQR] consumption low-dose was 10 [0–12] 0 [0–10], a 95% CI -1 (p = 0.016). In matched group, there difference 8 mg/dL (95% CI, -2 7, P < 0.05) immediate glycaemia, 17 mg/dl 14, glycaemia at 24 hours day 0, stay. No differences scale complications found.Conclusion High-dose slightly increased perioperative glycemia while reducing significantly shortening

Язык: Английский

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Evaluating the Use of Dexamethasone in Diabetic Patients Undergoing Total Joint Arthroplasty: A Systematic Review and Meta-analysis

The Journal of Arthroplasty, Год журнала: 2024, Номер unknown

Опубликована: Дек. 1, 2024

Язык: Английский

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